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Custom Mould For A Made-To-Measure Breast Implant

Arkansas rates for HCPCS 19396

An impression of the chest is taken and shaped so that a breast implant can be manufactured to match the individual's own contour. It is the preparatory step used when a standard, off-the-shelf implant would not fit the chest wall well, and the finished implant is placed inside the body at a later operation.

Rates data updated July 2026.

Facilitymedian $1,820 · 10th–90th $209$3,9810%10%10th90th$1,820Professionalmedian $234 · 10th–90th $129$3720%10%10th90th$234$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$1,230.27
Typical High
$1,995.26
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$229.09
Typical High
$338.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$3,467.37
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$186.21
Typical High
$354.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$3,467.37
Typical High
$3,467.37
Cigna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$257.04
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$3,162.28
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$239.88
Typical High
$446.68